Definitions and controversies

Abstract

Introduction The management of the menopausal and postmenopausal woman is an area where gynaecologists also become physicians, dealing not only with the consequences of ovarian failure but also of ageing. Estrogen deficiency affects many organ systems and a holistic approach is required. Postmenopausal health is a growing area of medicine as populations are ageing. The average age of the menopause, or last menstrual period, is 52 years. Current smoking, lower educational attainment, being separated/widowed/divorced, unemployment, Down syndrome and a history of heart disease are associated with earlier natural menopause, while parity, prior use of oral contraceptives and Japanese race/ethnicity are associated with later age at natural menopause. Definitions Various definitions are in use and are detailed in Box 1. Stages of reproductive ageing A staging system that uses the final or last menstrual period as the key event to describe reproductive ageing was proposed by the Stages of Reproductive Aging Workshop. In this system, five stages precede and two stages follow the final menstrual period. Stages –5 to –3 encompass the reproductive interval, stages –2 and –1 are the menopausal transition and stages 1 and 2 are the postmenopause. After menarche (stage –5), it usually takes several years for regular menstrual cycles to become established. Menstrual periods should then occur every 21–35 days for a number of years (stages –4 and –3).